I am sufficiently long in the tooth to remember UMT’s (Units of Medical Time). My first contract as a House Officer was for 40 hours plus 18 class A UMTs. Essentially a class A UMT was 3 hours of time worked for which I was paid 1 hour. So overtime at 33% and a working week of 94 hours.
Was it stressful? I can’t remember to be honest. I was too involved with patient care and staying awake and then trying to go out and socialise after work on the one evening I had off each week. Mind you, I was a cheap date in those days – I was so tired that after one pint I was asleep. Many a time, myself and my SHO and registrar would go to the pub and fall asleep in a corner with a pint gradually getting warmer in its glass in front of us.
It was hard work, and I am not condoning it, but I do feel that I was better equipped than todays junior doctors to look after Mrs Smith who, at 2am, was having chest pain. You see I had looked after Mrs Smith every day and every night for her entire stay on the medical ward, so I knew exactly what meds she was on, who her next of kin was, what her allergies were and what we had tried when she last had chest pain. I also had a “firm” to back me up. A Senior House office, a Registrar and a senior registrar. All of whom had been with me in the Doctors’ residence and on a daily ward round. The consultant was the final say, but we invariably had everything sorted by the time he got there the next morning.
My relationship with the Nursing staff was excellent because I appreciated and respected the seniority of the senior staff nurse and the Sister. They knew far more than I did. Many a time I would ask Sister what her opinion was, and she was invariably right. A great resource of knowledge and a useful ally.
Today junior staff come on shift at 11pm with no idea who their senior is, or who their consultant is. When the nurse, who may well be an agency nurse calls them at 2am to see Mrs Smith with chest pain, the junior, who has never met Mrs Smith before, is confronted with a set of notes that is as heavy as the patient. They then have to wade through the notes before ever setting a hand on poor Mrs Smith. How frustrating is that for the doctor, the patient and the nurse?
So what is the answer? It may be that the system realises that the old way is actually the best way, and that junior doctors need the support of a “firm”, but as well as that it is important for us all to look at our practice and find ways to go back to basics. Reduce stress and do what you do best – be a doctor!